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Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: a global ecological risk assessment

Published online by Cambridge University Press:  02 January 2007

Jeremy A Lauer ,
Ana Pilar Betrán ,
Aluísio JD Barros  and
Mercedes de Onís
Jeremy A Lauer*
Affiliation:
Department of Health Systems Financing, Expenditure and Resource Allocation, World Health Organization, 1211 Geneva 27, Switzerland
Ana Pilar Betrán
Affiliation:
Department of Making Pregnancy Safer, World Health Organization, Geneva, Switzerland
Aluísio JD Barros
Affiliation:
Department of Social Medicine, Federal University of Pelotas, CP 464 – 96001-970, Pelotas, Brazil
Mercedes de Onís
Affiliation:
Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
*
*Corresponding author: Email lauerj@who.int
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Abstract

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Objective

We estimate attributable fractions, deaths and years of life lost among infants and children ≤2 years of age due to suboptimal breast-feeding in developing countries.

Design

We compare actual practices to a minimum exposure pattern consisting of exclusive breast-feeding for infants ≤6 months of age and continued breast-feeding for older infants and children ≤2 years of age. For infants, we consider deaths due to diarrhoeal disease and lower respiratory tract infections, and deaths due to all causes are considered in the second year of life. Outcome measures are attributable fractions, deaths, years of life lost and offsetting deaths potentially caused by mother-to-child transmission of HIV through breast-feeding.

Setting

Developing countries.

Subjects

Infants and children ≤2 years of age.

Results

Attributable fractions for deaths due to diarrhoeal disease and lower respiratory tract infections are 55% and 53%, respectively, for the first six months of infancy, 20% and 18% for the second six months, and are 20% for all-cause deaths in the second year of life. Globally, as many as 1.45 million lives (117 million years of life) are lost due to suboptimal breast-feeding in developing countries. Offsetting deaths caused by mother-to-child transmission of HIV through breast-feeding could be as high as 242 000 (18.8 million years of life lost) if relevant World Health Organization recommendations are not followed.

Conclusions

The size of the gap between current practice and recommendations is striking when one considers breast-feeding involves no out-of-pocket costs, that there exists universal consensus on best practices, and that implementing current international recommendations could potentially save 1.45 million children's lives each year.

Keywords

Breast-feedingRisk assessmentPopulation-attributable riskMother-to-child transmissionBurden of disease
Type
Research Article
Information
Public Health Nutrition , Volume 9 , Issue 6 , September 2006 , pp. 673 - 685
Copyright
Copyright © The Authors 2006

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